If a rash persists for a prolonged period of time, it may be indicative of a more serious disease. A dermatologist is the best physician specialist to examine your rash and determine whether additional treatment or a biopsy may need to be done.


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The vast majority of rashes are annoying but not life threatening. Eczema is a term that is frequently utilized by physicians and the popular press. It literally means "to boil" and is descriptive of some of the oozing or blistering lesions that characterize this common skin affliction. Think of the chronic hand dermatitis or the rough patch of thickened skin that you are always scratching and you have an excellent idea of what eczema is. However, as commonplace as this diagnosis is, it is also very non-specific. Eczema may be caused by ingestion of food products, by exposure to the sun or environmental elements, or even by infections in other parts of our body, resulting in a skin rash that is seemingly unrelated. However, the causes of most cases of eczema still remain unknown.

If a rash persists after a period of several weeks, is painful or blistering, or becomes secondarily infected, you should see a dermatologist. Sometimes a course of antibiotics, either topical or oral, is needed to eliminate an infection and enable the dermatologist to view the actual rash with greater clarity. If after localized or systemic treatment, a rash persists, a dermatologist may elect to do a biopsy.

When a dermatopathologist reviews the biopsy, the cause can often be narrowed to a few specific choices. Rarely, there may be clues to a more sinister diagnosis, a cutaneous lymphoma. As discussed in the feature article, this is a group of rare but very serious skin diseases that may present with a waxing and waning appearance over the course of weeks to months and even years. Although a dermatologist may suspect the disease based upon clinical observation, only a dermatopathologist can render and confirm the correct diagnosis. At times, the dermatopathologist may utilize additional sophisticated testing requiring special stains that encompasses monoclonal antibodies to a variety of proteins or gene rearrangement studies to confirm the diagnosis. However, the final diagnosis will only be arrived by a joint discussion between the dermatopathologist and the referring dermatologist to ensure there is a good clinical-pathologic correlation. In this way, the optimal treatment may be rendered.

Any medical word that ends with "-itis" implies inflammation. Familiar diseases such as appendicitis can now be clearly understood as inflammation of the appendix. A dermatitis is any inflammation of the skin (derm). Broadly speaking, one can divide a dermatitis into acute (recent onset within the past few days) and chronic (weeks to months and years). However, some diseases may show elements of both. The photo above and to the right illustrates the characteristic changes of atopic dermatitis. This patient has changes of both an acute (characterized by the new red papules) and chronic (characterized by the linear lines caused by constant scratching).

Additional Links

The Doctor's Doctor-Skin Rashes

The Doctor's Doctor-Basic Principles of Disease